Part 2 MRCOG: EMQs (extended matching questions)

This page provides information on the extended matching question (EMQ) component of the Part 2 MRCOG exam.

Answering the questions

Each EMQ answer sheet is numbered 1–50. Against each number there are 20 lozenges labelled A–T (not all the letters A–T may be used eac time).

Each question in the question booklet consists of an option list (lettered to reflect the answer sheet), a lead-in statement (which tells you clearly what to do) and then a list of 1–5 questions (numbered to match the answer sheet).

Although the answer sheet provides for 20 possible answers, the option lists for questions may not use all of these. Most option lists have 10–14 answer options. The options lists will nearly always be in alphabetical or numerical order for ease of reference. If not, they will be in the most appropriate order for quick reference.

To answer the question, select the single answer that best fits. You may feel there are several possible answers, but you must choose only the most likely answer from the options list.

Marking

Each correct answer is awarded 1 mark. Incorrect answers are not penalised: each incorrect answer is awarded 0 marks. It is in your best interests to ensure you fill in one lozenge for each of the EMQs by the end of the exam.

If you mark 2 or more lozenges on the same question, 0 marks will be awarded, even if one of your answers is correct. Please ensure any mistakes are clearly and fully erased.

Example questions

Where answers are provided to these examples, the questions have been removed of the bank of live questions that can be used in actual exams (although the same options lists may remain with different tested scenarios).

Some of the sample questions do not have answers. This is to encourage candidates to seek out information themselves and thus learn actively. These questions remain in the bank and may reappear in the exams. The same options lists may recur with different tested scenarios.

Options for questions 1–2

A.

Amniotic fluid embolism

I.

Placental abruption

B.

Cardiomyopathy

J.

Placenta praevia

C.

Chest infection

K.

Pulmonary embolism

D.

CVA

L.

Pulmonary hypertension

E.

Endocarditis

M.

Sepsis

F.

Haemorrhage

N.

Substance misuse

G.

HELLP syndrome

O.

Thromboembolism

H.

Myocardial infarction

Instructions

For each case described below, choose the single most likely cause of maternal death from the above list of options. Each option may be used once, more than once, or not at all.

Question 1: A previously healthy 18-year-old primigravida presents at 36 weeks feeling unwell and tired. Her brother died unexpectedly aged 19 years. Her CXR showed an enlarged heart. While being admitted she developed increasing shortness of breath and died despite intensive resuscitation.

Answer: B. Cardiomyopathy

Question 2: A 30-year-old woman, 28 weeks of gestation in her sixth pregnancy, presents to A&E with breathlessness and displays severe anxiety. She had complained of left-sided pelvic pain for a week. While being assessed she collapsed and it was not possible to resuscitate her.

Options for questions 3–4

A.

Atrophic vulvovaginitis

H.

Human papillomavirus infection

B.

Benign mucous membrane pemphigoid

I.

Lichen planus

C.

Candida infection

J.

Lichen sclerosus

D.

Contact dermatitis

K.

Lichen simplex et chronicus

E.

Eczema

L.

Psoriasis

F.

Herpes simplex infection

M.

Vulval intraepithelial neoplasia

G.

HIV infection

N.

Vulvodynia

Instructions

For each clinical scenario below, choose the single most likely diagnosis from the list above. Each diagnosis may be used once, more than once, or not at all.

Question 3: A 23-year-old woman presents with a two-year history of vulval, perineal and perianal irritation. The vulva is red, excoriated and there areas of white, thickened skin. Application of 3% acetic acid shows areas of mosaic and coarse punctuation.

Answer: M. Vulval intraepithelial neopasia

Question 4: A 78-year-old woman presents with vulval irritation and soreness. On examination the vulva is red in colour, slightly oedematous and there are small, red papules scattered randomly beyond the perimeter of the vulva. She also complains of soreness and irritation under the breasts.

Options for questions 5–7

A.

Antihypertensive treatment

H.

Measure serum magnesium

B.

Calculate the mean arterial blood pressure

I.

Monitor patellar reflex every 15 minutes

C.

Carry out field assessment

J.

Provide a fluid challenge with colloids

D.

Immediate dose of 10 ml 10% calcium gluconate intravenously

K.

Provide intravenous Hartmann’s solution at the rate of 85 ml per hour

E.

Insert central venous pressure line

L.

Transfer to intensive treatment unit

F.

Intravenous magnesium sulphate

M.

Transfer to the postnatal ward

G.

Measure serum aspartate transaminase immediately

Instructions

For each patient described below choose the single most appropriate initial treatment option from the list. Each option may be used once, more than once, or not at all.

Question 5: A 20-year-old primigravida had a normal delivery of a live infant 12 hours previously. She has developed severe gestational proteinuric hypertension, her clotting is normal, serum albumin is 43 g/dl, there is no ankle clonus and her blood pressure is 160/100 mmHg. She has been given one litre of Hartmann’s solution intravenously since her delivery and has been anuric. The central venous pressure is +10 mmHg, serum sodium 132 mmol/l, serum potassium 7.1 mmol/l and serum urea 22 mmol/l.

Answer: L. Transfer to intensive treatment unit

Question 6: A 20-year-old primigravida delivered a live infant 24 hours previously. She has developed severe gestational proteinuric hypertension. Treatment with intravenous magnesium was required. Her fluid balance is satisfactory and serum urea, electrolytes and clotting profile are all normal. Her respiratory rate falls to 6 per minute and she is drowsy but rousable.

Question 7: A 20-year-old primigravida is 30 weeks pregnant and has been transferred to the delivery suite with severe gestational proteinuric hypertension. She complains of severe frontal headache but has no other symptoms. She has a normal respiratory rate and her urine output has been satisfactory. Her blood pressure is 140/100 mmHg. There are five beats of bilateral ankle clonus.

Options for questions 8–10

A.

Damage to bladder/ureter

I.

Laparotomy

B.

Damage to bowel

J.

Pain

C.

Failure rate 1 in 100

K.

Premature menopause

D.

Failure to gain entry into abdominal cavity

L.

Removal of ovaries

E.

Failure to identify disease

M.

Urinary retention

F.

Failure to visualise uterine cavity

N.

Uterine perforation

G.

Haemorrhage requiring blood transfusion

O.

Vaginal bleeding

H.

Haemorrhage requiring return to theatre

Instructions

For each of the case histories described below, choose the single most relevant complication that you must discuss with the patient when taking consent prior to surgery from the above list of options. Each option may be used once, more than once, or not at all.

Question 8: A 52-year-old woman with frequent heavy periods is listed for diagnostic hysteroscopy. She has had two children, both delivered by caesarean section. She is hypertensive and her BMI is 26.

Answer: N. Uterine perforation

Question 9: A 56-year-old woman is scheduled for laparotomy and possible bilateral salpingoophorectomy for an ovarian mass. She had a total abdominal hysterectomy at the age of 40 for fibroids and is in discomfort with an ovarian mass which measures 15 cm in diameter on ultrasound examination.

Question 10: A 48-year-old nulliparous woman is scheduled for vaginal hysterectomy because of menorrhagia. Her uterus is enlarged equivalent to 14 weeks of gestation.